Healing the rift – rebuilding professional relationships to enhance patient safety

Addressing breakdowns in professional relationships in healthcare requires a proactive approach

Communication often is considered a ‘soft skill’ in the workplace, but its value – particularly when providing patient care – should not be underestimated. Communication breakdowns between members of healthcare teams are not uncommon, and they can result in anything from minor confusion to serious patient harm.

The new Medical Council Guide to Professional Conduct and Ethics for Registered Medical Practitioners (‘the Guide’), due to come into effect in January 2024, highlights the importance of good communication and interpersonal skills for doctors.

The Guide states: “Medical practitioners must demonstrate effective interpersonal communication skills. This enables the exchange of information, and allows for effective collaboration with patients, their families, and also with clinical and non-clinical colleagues and the broader public.”

The Guide further emphasises the importance of clear lines of communication within teams in order to protect patients. It states: “Medical practitioners must co-operate with colleagues and work effectively with healthcare professionals from other disciplines and teams. He/she should ensure that there are clear lines of communication and systems of accountability in place among team members to protect patients.”

Communication with colleagues

Successful communication amongst healthcare clinicians and staff members has always been a crucial element of patient safety. The emphasis on communication has become more important in recent years, with increasing integration between the hospital sector and community-based care being one of the key strategies of Sláintecare. As these changes occur communication remains a high-risk factor while also being a common feature in medical negligence claims and complaints in Medisec’s experience.

Certain steps along the patient care journey can be particularly vulnerable to poor communication and errors, often leading to patient harm such as delays in treatment, misdiagnosis, or a delay in diagnosis.

Particular challenges arise when there are multiple staff involved in providing patient care across several different sectors of the healthcare system, and, in particular, the interface between primary and secondary care. Regardless of the situation, transitions of care require accurate and clear communication between all members of the healthcare team and the patient.

When professional relationships break down

Effective teamwork and collaboration amongst colleagues are essential to providing high-quality, safe patient care. However, poor professional relationships within healthcare teams can hinder productivity, compromise patient safety, and create a negative work environment. Professional relationships can break down for a myriad of reasons ranging from simple misunderstandings to deep-rooted insecurities, a need for validation, or a fear of being overshadowed by others.

Some individuals may display traits such as excessive competitiveness, resistance to collaboration, and possession of a superiority complex. Furthermore, inadequate staffing and the pressures of workload can all contribute to the development of poor behaviour and difficult relationships between colleagues.

The Royal College of Surgeons, UK, has identified the following as examples of disruptive behaviour, which have been identified in the literature:

• Bullying or intimidation, abusive or offensive language or sarcasm;
• Loud, rude comments;
• Outbursts of anger;
• Sexual harassment and other harassment;
• Racial, ethnic, or sexist slurs;
• Persistent lateness in responding to work calls or requests;
• Throwing instruments or breaking things;
• Use of, or threats of, violence, retribution, or vexatious litigation;
• Passive aggression including refusal to comply with known and generally accepted practice standards, intentional miscommunication;
• Unwillingness to discuss issues with colleagues in a cordial and respectful manner, including handover meetings;
• Failure to work collaboratively or cooperatively with others;
• Mocking, shaming, disparaging, or censuring patients, colleagues, and others involved in the provision of healthcare;
• Unethical or questionable practices.

The consequences of disruptive behaviour can be both immediate and long-term. Of greatest concern is the impact this behaviour can have on the care of patients.

There is widespread evidence illustrating the impact of disruptive clinicians on patient care. A recent systematic review exploring the impact of unacceptable behaviour between healthcare workers on clinical performance and patient outcomes identified that this behaviour negatively affects the clinical performance of healthcare workers, quality of patient care, workplace productivity, and patient outcomes. One study across 102 hospitals in the US identified that 18 per cent of staff reported an awareness of a specific adverse event that resulted as a direct consequence of disruptive behaviour. A more recent survey of doctors and nurses in over 100 hospitals in the US highlighted that 71 per cent of respondents felt that disruptive behaviour contributed to medical errors.

In addition to patient safety issues, the damage from disruptive behaviour can also have a negative impact on employee morale and job turnover.

The Medical Council provides very clear guidance concerning disruptive behaviours. Paragraph 55.1 of the Guide states: “You must be aware of the impact of your conduct on your colleagues, including how this may affect the quality of care and treatment of patients. You must behave respectfully towards all colleagues, including students. You must not engage in any form of bullying, harassment, abuse, discrimination, undermining of colleagues, or condone such behaviour by others. This applies to all interactions, including social media and networking sites.”

In addition, the Medical Council advises: “When disputes between colleagues arise, this should be addressed appropriately and promptly, and should not affect patient care. You should not denigrate a colleague or a colleague’s practice.”

Practical tips to healing the rift

Conflict is inevitable in any workplace, including healthcare settings. When dealing with disruptive behaviour, it is essential to address issues promptly and effectively at the earliest possible convenience to prevent them from escalating further. Early recognition of relationship breakdown, including the traits and contributory factors, can assist healthcare professionals in approaching their colleagues with empathy and understanding. The following are some practical tips that may help you manage such a challenging situation:

Extend the olive branch: Simply ‘extending an olive branch’ may be the first step to help settle a dispute or resolve a difficult issue. For some people, this may take an immense amount of courage to take this action as it often comes with an admission of wrongdoing or regret.

Effective communication: Effective, clear, open, and honest communication is essential when managing difficult situations. It is crucial to maintain open lines of communication. Be aware of your tone of voice and body language as they can often portray a different image than the spoken word.

Assertive communication: Assertive communication techniques can facilitate you to express your own needs, concerns, and boundaries while also helping to establish clear expectations and mutual respect.

Active listening: Actively listen to colleagues’ concerns, ideas, and feedback. This can greatly help to diffuse any tension and foster a relationship of mutual respect. This approach demonstrates that their opinions are valued and may encourage them to reciprocate.

Constructive feedback: When providing feedback focus on the behaviour or actions rather than the person. Clearly communicate the impact of their actions on the care of the patient and the wider team, emphasising the need for teamwork and future collaboration.

Seek mediation: If conflict and disruptive behaviours persist you may need to seek the assistance of a third party such as a line manager or human resources representative. Their objective perspective may help to facilitate a mutually agreeable resolution whilst also ensuring fairness.

Create a positive work environment: Creating a positive workspace, where individual team members are valued and respected, can mitigate the negative impact of difficult and disruptive behaviours within a team. You may wish to consider team-building activities that foster camaraderie and strengthen relationships. It is also important to celebrate both individual and team achievements. This can go a long way to boost morale and create a positive atmosphere.

Professional development: Encourage colleagues to pursue professional development opportunities, such as having a professional development plan and attending conferences and educational events. This approach can foster a growth mindset that will aim to focus on personal career development rather than comparison with others.

Conclusion

Addressing breakdowns in professional relationships in healthcare requires a proactive approach that focuses on effective communication, mutual respect, collaboration, and conflict resolution. By embedding these practical solutions, healthcare organisations and teams can foster a positive work environment that focuses on and supports the delivery of high-quality, safe patient care.

References available on request